Legaland ethical authority of parents over children’s medical care is a key part oftheir parental role to enhance children’s health. Many literatures showed that,decision making in childhood cancer is a critical issue to parents as theyrequired to face a strange situation and to make a decision that will affecttheir child health and life span. According to Stewart, Pyke-Gerimm, &Kelly 2012, it is a nature extension of the parental role to make the correctdecision for their child and ensure the best results. Moreover, they mentionedthat parents often show desire of more involvement in decisions about treatmentthan what they actually experience however, few parents preferred physician totake full responsibility for decision-making because of lack of their medicalexperience. Decision making process can be highly ethical if it resulted ofcollaboration between the active role of physicians as a result of theirknowledge and experience and parents authority by approving the recommendchoices by physicians (Stewart, Pyke-Gerimm, & Kelly 2012).
Therefore, manyprotocols and policies have been developed to provide parents with theappropriate information and help their participation in decision making such asinformed consent. According to McKenna et al., 2009, parents should lead thedecision in treatment choices because they certainly will make the appropriatedecision, while this approach could make parents feel guilty if their decisiondid not lead to a desired outcome. Subsequently, health care providers arerequired to provide support and information to parents, to help them with thepossible difficulties that might occur during treatment process and enhancetheir satisfaction with their decision. Despite parental decisions usually willoptimise the child’s well-being, but sometimes their choices harm the child.Therefore, Parent’s authority to make medical decisions must not be unlimitedspecially when they disagree with the recommended treatment by physician orwithdraw children from treatment, in order to maintain clinical ethics,parents-physician shared decision making is preferable (McKenna et al., 2009).Disclosureof childhood cancer to family is a difficult procedure and requires physicianto deal with many stressors, including decision making in terms of treatment.
Historically physicians are ideally positioned to lead clinical decision makingprocess. Series of ethical challenges physicians are facing when makingtreatment decisions. They are required to weigh the consequences of theiractions; by providing maximum benefit and avoiding harm, as well they are haveto support the role of parents, and consider child’s wishes (Friebert , 1999). According to Simons et al., 2006), physician’s role is to provideinformation for patients and their families to enable them to take their owndecision rather than making decisions for them. On the other hand Whitney et al.
,(2006) said, physicians should integrate ethical practice of medicine with therealities of clinical medicine to ?nd the right treatment choice for oncologychild, and then recommend to child and family a particular clinical decision, especiallywhen there is one clear best medical option. Ethically, I believe thatphysician has the decisional priority to indicate the most effective treatmentapproach, based on knowledge and the best available treatment, and then comesthe role of the parents to exercise decisional and legal authority. Childhoodcancer is the cancers that occur in children younger than 18 years. Althoughcancer is uncommon in children, it is has been classified the leading cause ofdeath in children, despite the advances in the treatment of cancer.
There areno known causes of childhood cancer, and it occurs across all ethnic groups;moreover, some children are even born with cancer. A diagnosis of childhoodcancer is a shock for family and child; it produces major emotional distress,and affects children and family life balance. The known nature of cancer, beingas life-threatening disease, as well as risks associated with treatment, makesdecision making process stressful and difficult. According to Whitney et al., 2006, clinicaldecision making for children with serious illness such as cancer has asignificant challenge for physicians, parents, and patients, and it isaccompanied with ethical issues. Unliketreatment decision in adult patient, it is internationally declared thatchildren under the age of majority are legally ineligible to make decisionsabout their own health care.
While, parents or guardians are authorized, todecide for treatment for minor patients, however, medical decisions must bebased on the child’s best interest, such treatment effectiveness, possibilitiesof additional suffering from side effects, and overall prognosis. Furthermore,healthcare professionals and related ethical issues can affect also decisionmaking in childhood cancer. Accordingly, this paper aims to discuss number ofkey themes related to decision making in pediatric oncology; physician’s role in decision making inchildhood cancer; parents’ participation in treatment decisions and the factorsthat might affect their decisions; parent’s view of participation of child inclinical trials. Following this, I will look at particular aspects with ethicaldilemmas: refuse of treatment, do not resuscitate (DNR) in children, andend-of-life care for children.
Finally I will offer own thoughts and hypothesisabout topic.